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People often ask me whether performing pet euthanasia is the worst part of my job. In fact it’s not exactly the worst part of the job, but it certainly is the hardest and most emotionally challenging part. Because I can decline to perform so-called “convenience euthanasia” — people who want their cats put down because they have new furniture they don’t want scratched, or maybe they’re moving and don’t want to take the cat with them, or similar reasons — virtually all of the cats I have put down have been sick and suffering. Euthanasia was a way to help them. But performing euthanasia is always hard, and in fact it doesn’t get easier. It keeps getting harder as the years go on.

Euthanasia is indicated for a cat when two conditions are met. First, the cat must be suffering. Second, there must be no other way to alleviate the suffering. The second condition can get into a tricky area when (as it usually is) money is involved. Sometimes there is no treatment option that will work, period. Other times a certain treatment option might work, but it would cost thousands of dollars — and the owners simply can’t afford it. These cases of financial hardship are especially emotionally challenging for me. Some might wonder why I can’t offer discounted or free services in such cases. The answer is that if I did, I would be bankrupt, homeless, and starving. The need, unlike my resources, is unlimited.

Some cats are euthanized because they are no longer wanted or because their owners’ circumstances make it impossible to continue to own a cat. As I said, I do not perform these so-called convenience euthanasias. If a cat is healthy and free of significant problems, I won’t put him to sleep. As I also said, this is a luxury. Some vets’ bosses don’t allow them to say no (and the veterinary job market these days is such that most vets can’t afford to lose their jobs). Instead of performing a convenience euthanasia I offer counseling on finding a new home for the cat. However, I don’t fool myself. I know that many of these cats are put so sleep elsewhere, by a veterinarian whose soul must be crushed by it.

Behavioral problems are a leading cause of euthanasia in cats. And by behavioral problems I mean one thing almost exclusively: urinating outside of the litter box. Again, I can refuse to euthanize many of these cats. This is mostly because I work at an emergency clinic, and behavior problems usually are addressed by family vets. Also, euthanasia for house soiling can be avoided by behavioral modification or, as a last resort, allowing the cat outdoors.

The cats I euthanize are sick and suffering. That makes it less difficult, but it’s still hard. As compared with general practitioners, I euthanize more animals during an average shift. When I worked as a general practitioner, I thought putting down three animals in a day was extreme. I don’t think that anymore.

People ask whether I have become numb to euthanasia — whether it has gotten easier over time. In fact, the opposite is true. Euthanasias have become more emotionally trying for me over my career. I don’t know why this happens, but it is common among my friends and colleagues.

The most difficult type of euthanasia for me usually involves a very elderly cat and a rather young man or woman. These people have had the cats for as long as they can remember. They are young enough never to have experienced any other significant loss in their lives. Some of them try not to cry; others let the tears flow. All of their lives are forever changed.

Different vets employ different euthanasia protocols. I use the one I do because I believe it is the most humane way to euthanize a cat.

It is very important to me that a cat not suffer any pain or distress in his final moments. The procedure starts with the placement of an intravenous catheter. The catheter allows medications, including euthanasia solution, to be administered without puncturing the cat’s skin with needles during the procedure. Most cats tolerate catheter placement remarkably well. It is not especially painful.

Placement of the catheter is contingent upon the cat not being distressed. If the cat is nervous, I administer a tranquilizer before placing the catheter. If the tranquilizer does not relieve stress sufficiently, I forego the catheter.

I perform the euthanasia itself as a two-step process. The first step is called premedication. Cats with catheters receive a medication called propofol that causes them rapidly to fall asleep (usually in less than 30 seconds). Cats without catheters usually receive a medication called Telazol, which is injected under the skin and takes effect in five minutes to 10 minutes. Either way, the cat is not aware of what happens next.

The act of euthanasia is performed with an intravenous overdose of an anesthetic medication called pentobarbital. It usually takes effect in just a few seconds. Some cats may lick their lips as the medication takes effect. Many will lose bowel or bladder control after the procedure. Most cats do not close their eyes. Some take a few short breaths after they pass away (these so-called agonal breaths are a reflexive action of the muscles of the chest).

Then it is over. If the cat’s owner is present for the procedure I excuse myself promptly to allow for mourning in private. Most people choose to have their cats cremated. Some request to have the ashes returned to them; others request that the ashes be buried or scattered with those of other pets. A smaller number request burial without cremation, or they take their deceased cat home. All of these options can be accommodated at most veterinary clinics, including the one where I work.

Euthanasias are very emotional for vets. Even writing about them is hard. I take comfort from the fact that the euthanasias I perform are the best way to alleviate the cats’ suffering. But that fact is cold comfort indeed.

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